Ibraheem Waleed I, Abass Osama A, Toema Ahmed M, Yehia Ahmed M
Department of Cardiothoracic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Department of Cardiothoracic Surgery, Faculty of Medicine, Helwan University, Helwan, Egypt.
J Card Surg. 2019 Nov;34(11):1162-1171. doi: 10.1111/jocs.14234. Epub 2019 Sep 2.
An anomalous origin of the right coronary artery (RCA) from the left sinus of Valsalva with an interarterial course is a rare congenital anomaly. We aimed to assess midterm results after coronary artery bypass grafting (CABG) for the treatment of anomalous RCA arising from the left sinus of Valsalva.
From 2008 to 2012, 16 patients underwent CABG for treatment of an anomalous origin of the RCA from the left sinus of Valsalva. Details such as risk factors, operative details, and results of multislice coronary angiography follow-up were assessed.
The mean age of the patients was 34.8 ± 4.68 years, and most of them were male (15 out of 16, 93.75%). They received a mean of 1.5 ± 0.87 grafts. Closure of the RCA was completed in all patients except one (15 out of 16), who developed ischemic symptoms upon closing the proximal part of the RCA. One in-hospital death occurred. Among the remaining patients, symptoms persisted in 2 out of 15. The mean follow-up time was 63.4 ± 28.6 months. All patients had patent vessels on 5-year follow-up multislice computed tomography scans, except one patient who showed RCA graft occlusion on the 1-year follow-up scan.
The CABG of the RCA with anomalous origin can be done safely with excellent early and midterm results. Proximal RCA ligation is an essential step to the success of CABG, but intraoperative challenge testing is required to confirm the sufficiency of the internal thoracic artery graft to reperfuse the supplied territory.
右冠状动脉（RCA）起源于左冠窦且走行于动脉之间是一种罕见的先天性异常。我们旨在评估冠状动脉旁路移植术（CABG）治疗起源于左冠窦的异常RCA的中期结果。
2008年至2012年，16例患者接受CABG治疗起源于左冠窦的异常RCA。评估了诸如危险因素、手术细节以及多层冠状动脉造影随访结果等详细情况。
患者的平均年龄为34.8±4.68岁，大多数为男性（16例中的15例，93.75%）。他们平均接受了1.5±0.87支移植血管。除1例患者外，所有患者（16例中的15例）的RCA均完成了闭合，该例患者在闭合RCA近端时出现缺血症状。发生1例院内死亡。在其余患者中，15例中有2例症状持续存在。平均随访时间为63.4±28.6个月。在5年随访的多层计算机断层扫描中，所有患者的血管均通畅，除1例患者在1年随访扫描时显示RCA移植血管闭塞。
起源异常的RCA进行CABG可安全实施，早期和中期结果良好。RCA近端结扎是CABG成功的关键步骤，但需要术中激发试验来确认胸廓内动脉移植血管对供血区域再灌注的充分性。
